And I'm sure that services will totally not get worse when you remove the last human in the loop from the money extraction machine that is the health insurance industry.
And I'm sure that services will totally not get worse when you remove the last human in the loop from the money extraction machine that is the health insurance industry.
Think of it this way: is it really an efficient allocation of economic resources to have so many educated people working in healthcare bureaucracy? As the essay points out, the number of admin...
Think of it this way: is it really an efficient allocation of economic resources to have so many educated people working in healthcare bureaucracy? As the essay points out, the number of admin have grown at a 10x rate that of physicians.
Probably not, but finding another job isn't easy. What businesses are expanding? What do they need people to do? A lot of the job creators want to use AI instead.
Probably not, but finding another job isn't easy. What businesses are expanding? What do they need people to do? A lot of the job creators want to use AI instead.
It's the age old problem with automation. It's supposed to make people's lives better, and for the most part is has; but the damage to the peoples' whose jobs it replaces is real and isn't easy to...
It's the age old problem with automation. It's supposed to make people's lives better, and for the most part is has; but the damage to the peoples' whose jobs it replaces is real and isn't easy to recover from for a long time.
Historically automation only affected "low skill" labor so it might have been possible for people to "trade up to better jobs" so to speak. We've never really been in a position where automation was threatening so many "high skill" jobs, so its hard to say what the future looks like. Ideally the end goal is a society where people don't have to work (or at least don't have to work on anywhere near the level they do today,) but I just don't see how that ever becomes possible unless there is a drastic shift in how the profits from automating all these jobs away gets shared. Right now the only people "winning" by jobs getting automated away are the shareholders.
A good beuracracy has lots of people to insure things actually get done. A bad beuracracy has 1 person taking the blame for an AI fucking up 10,000 faster than a human. Firing the people in the...
A good beuracracy has lots of people to insure things actually get done. A bad beuracracy has 1 person taking the blame for an AI fucking up 10,000 faster than a human. Firing the people in the loop just results in a worse beuracracy.
Have you ever been able to resolve an edge-case problem quickly by clicking through 10 layers of phone prompts? No, you get the problem solved by talking to an actual human.
Everything service I use that has deployed AI agents to "help customers" uses it as an excuse to make the service even shittier. Because AI will handle the FAQ fine. But if your problem isn't on the FAQ you're SOL.
The proper way to improve efficiency is to murder the health insurance industry.
My doc has said he could double his patient count if he only took Medicare or cash.
I've heard a good chunk of hospital admin positions exist solely to deal with the complicated minefield that is the US healthcare insurance industry. They have different requirements and policies,...
I've heard a good chunk of hospital admin positions exist solely to deal with the complicated minefield that is the US healthcare insurance industry. They have different requirements and policies, so even simple and routine bills take up time because they have to double-check that the paperwork fits that particular insurer's requirements.
That said, it feels like AI might be able to help in that particular area a little bit? Not by replacing humans entirely, but handling the lower level stuff (e.g. filling out the routine paperwork and ensuring codes match the respective companies' standards). That would leave humans more time to handle negotiating and arguing for the more complex cases.
At the very least, that unfortunately seems like a more actually feasible course of action to maybe reduce costs and reallocate funding than overhauling or killing the health insurance industry.
Besides that though... From what I've gathered, even outside insurance, there's a lot of bloat in hospital bureaucracy right now. Most of my knowledge is purely anecdotal, but at the peak of the pandemic I remember many, many, many nurses venting about the admin bloat at their hospitals and clinics on reddit. Particularly at the corporate level, but even admins in their buildings caused frustration because they couldn't/wouldn't advocate for their staff to corporate due to a mix of selfish priorities and just not understanding what the floor is actually like.
It actually hinders the medical staff's ability to do their jobs because people with no experience with patients were in charge of everything. Putting out impossible schedules, keeping facilities understaffed, doing the bare minimum in ordering and distributing equipment, organizing meetings over trivial things that genuinely wasted time but looked good for the admins, different departments lobbing responsibilities back and forth like tennis...
Honestly the unfortunate thing is that the ones causing the most problems seem to be those who are harder to replace by AI. There's definitely something really messed up with the bureaucratic side of American hospitals beyond dealing with insurance.
I'm not going to defend the administrative bloat of many systems. But there is little distinction between a system with excess capacity as a healthy redundancy; and systems that are bogged down...
I'm not going to defend the administrative bloat of many systems. But there is little distinction between a system with excess capacity as a healthy redundancy; and systems that are bogged down with excessive costs, meaningless middle-men, predatory contracts and being extorted by cronies. The former represents a system that provides stable employment and operational flexibility. The latter is sadly the reality that we are dealing with and the few functional actors in the system are over-extended to mitigate all the waste around them.
And the way I see it, AI is an attempt to replace those functional actors with an automated system that are the embodiment of excessive costs, meaningless middle-men, predatory contracts and cronies. All justified by the idea of "efficiency" and "cost effectiveness". Promises that are completely false.
I was interviewing someone that runs an insurance brokerage and he said that scaling with people is a linear cost while AI is flat. And it hit me on just how well obscured the costing was for average users. As if you can just pay openAI a fixed monthly cost and you could just spin up as many LLM instances as you want.
AI now is still in the first days of Uber and AirBnB. The company is going to eat a ton of the cost and plan to recoup it with interest once they capture the market and establish user dependency. True cost of LLM's often scale with the context size because the system reprocesses the entire instance with every time its invoked. Simpler analytical models can be linear but its often exponential. Advanced Multi-model and Agent systems multiply those costs.
My prediction is that AI will lead to the loss of hundreds of thousands of healthcare jobs, but few of these will be among physicians, allied health professionals (AHPs), and nurses, at least in the next decade.
...
Wander into the billing department of most large health systems, and you’ll witness hundreds of people optimizing documentation, drafting prior auth requests, and otherwise pushing reams of paper, often into fax machines. Amble over to the quality department, where you’ll see scores of workers reviewing charts for data to populate quality measurement spreadsheets, pay-for-performance schemes, and national registries in areas like interventional cardiology and transplantation. Head over to the population health department, whose personnel are struggling to remind patients that they’re overdue for a mammogram or a colonoscopy. The call center… well, you get the picture.
...
While administrative and operational jobs have expanded most rapidly, they’re also the most susceptible to AI replacement. The cuts have already begun. At UCSF Health, a decade ago, we started hiring human scribes to assist our busiest ambulatory clinicians in documenting their patient visits. At the program’s peak, about 100 of our busiest clinicians had a scribe – often a pre-medical student on a gap year. Today at UCSF, thousands of our doctors are now using scribes – but it’s no longer a 22-year-old pre-med supplied by a scribe staffing company; it’s an AI scribe supplied by a company named Abridge. Our clinicians are quite happy with their AI scribes (though some tell me they miss the opportunity to mentor the human scribes), and our expenses are a fraction of what they once were.
...
In contrast to the major cuts in administrative staff, I predict that very few doctors, nurses, or AHPs will lose their jobs, at least over the next decade. For nurses in the hospital, much of their work involves administering medications, assisting patients with toileting and mobility, inserting catheters and IVs, conducting complex assessments, counseling patients and their families, and responding to emergencies. For the foreseeable future, it’s more likely that AI and robots will assist nurses in performing their jobs more effectively – enabling them to practice closer to the top of their license – than replace those jobs entirely.
For physicians, even fields seen as highly vulnerable to job replacement by AI (particularly radiology and pathology) have proven exceptionally resilient. If you’d asked me 15 years ago which would come first: our radiologists would be unemployed, or I’d sit in the back seat of a driverless car without giving it a second thought, I would have assumed that the radiologists would be toast. Yet in San Francisco, we can’t hire radiologists fast enough, while Waymos are literally everywhere. (In my book, I describe why radiologists have been surprisingly shielded from job replacement.)
And I'm sure that services will totally not get worse when you remove the last human in the loop from the money extraction machine that is the health insurance industry.
Think of it this way: is it really an efficient allocation of economic resources to have so many educated people working in healthcare bureaucracy? As the essay points out, the number of admin have grown at a 10x rate that of physicians.
Probably not, but finding another job isn't easy. What businesses are expanding? What do they need people to do? A lot of the job creators want to use AI instead.
It's the age old problem with automation. It's supposed to make people's lives better, and for the most part is has; but the damage to the peoples' whose jobs it replaces is real and isn't easy to recover from for a long time.
Historically automation only affected "low skill" labor so it might have been possible for people to "trade up to better jobs" so to speak. We've never really been in a position where automation was threatening so many "high skill" jobs, so its hard to say what the future looks like. Ideally the end goal is a society where people don't have to work (or at least don't have to work on anywhere near the level they do today,) but I just don't see how that ever becomes possible unless there is a drastic shift in how the profits from automating all these jobs away gets shared. Right now the only people "winning" by jobs getting automated away are the shareholders.
A good beuracracy has lots of people to insure things actually get done. A bad beuracracy has 1 person taking the blame for an AI fucking up 10,000 faster than a human. Firing the people in the loop just results in a worse beuracracy.
Have you ever been able to resolve an edge-case problem quickly by clicking through 10 layers of phone prompts? No, you get the problem solved by talking to an actual human.
Everything service I use that has deployed AI agents to "help customers" uses it as an excuse to make the service even shittier. Because AI will handle the FAQ fine. But if your problem isn't on the FAQ you're SOL.
The proper way to improve efficiency is to murder the health insurance industry.
My doc has said he could double his patient count if he only took Medicare or cash.
I've heard a good chunk of hospital admin positions exist solely to deal with the complicated minefield that is the US healthcare insurance industry. They have different requirements and policies, so even simple and routine bills take up time because they have to double-check that the paperwork fits that particular insurer's requirements.
That said, it feels like AI might be able to help in that particular area a little bit? Not by replacing humans entirely, but handling the lower level stuff (e.g. filling out the routine paperwork and ensuring codes match the respective companies' standards). That would leave humans more time to handle negotiating and arguing for the more complex cases.
At the very least, that unfortunately seems like a more actually feasible course of action to maybe reduce costs and reallocate funding than overhauling or killing the health insurance industry.
Besides that though... From what I've gathered, even outside insurance, there's a lot of bloat in hospital bureaucracy right now. Most of my knowledge is purely anecdotal, but at the peak of the pandemic I remember many, many, many nurses venting about the admin bloat at their hospitals and clinics on reddit. Particularly at the corporate level, but even admins in their buildings caused frustration because they couldn't/wouldn't advocate for their staff to corporate due to a mix of selfish priorities and just not understanding what the floor is actually like.
It actually hinders the medical staff's ability to do their jobs because people with no experience with patients were in charge of everything. Putting out impossible schedules, keeping facilities understaffed, doing the bare minimum in ordering and distributing equipment, organizing meetings over trivial things that genuinely wasted time but looked good for the admins, different departments lobbing responsibilities back and forth like tennis...
Honestly the unfortunate thing is that the ones causing the most problems seem to be those who are harder to replace by AI. There's definitely something really messed up with the bureaucratic side of American hospitals beyond dealing with insurance.
I'm not going to defend the administrative bloat of many systems. But there is little distinction between a system with excess capacity as a healthy redundancy; and systems that are bogged down with excessive costs, meaningless middle-men, predatory contracts and being extorted by cronies. The former represents a system that provides stable employment and operational flexibility. The latter is sadly the reality that we are dealing with and the few functional actors in the system are over-extended to mitigate all the waste around them.
And the way I see it, AI is an attempt to replace those functional actors with an automated system that are the embodiment of excessive costs, meaningless middle-men, predatory contracts and cronies. All justified by the idea of "efficiency" and "cost effectiveness". Promises that are completely false.
I was interviewing someone that runs an insurance brokerage and he said that scaling with people is a linear cost while AI is flat. And it hit me on just how well obscured the costing was for average users. As if you can just pay openAI a fixed monthly cost and you could just spin up as many LLM instances as you want.
AI now is still in the first days of Uber and AirBnB. The company is going to eat a ton of the cost and plan to recoup it with interest once they capture the market and establish user dependency. True cost of LLM's often scale with the context size because the system reprocesses the entire instance with every time its invoked. Simpler analytical models can be linear but its often exponential. Advanced Multi-model and Agent systems multiply those costs.
From the article:
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